For three decades under federal law, anyone who shows up...

For three decades under federal law, anyone who shows up at a hospital needing care must get it regardless of ability to pay. Above, Lincoln Hospital's Emergency Room in the Bronx in 2006.

In 1986, President Ronald Reagan signed into law the Emergency Medical Treatment and Active Labor Act. It says anyone who shows up at just about any hospital seeking medical care must be examined and treated if he or she has a critical need. It also says patients cannot be released until they can care for themselves, or are sent to a situation in which they will be cared for.

That’s true even if the patient goes to a for-profit hospital and has no money or medical insurance. And the law also says patients have to be treated at that hospital if their needs are pressing, that they cannot be sent to a county facility or a nonprofit facility until they are stabilized.

Turning away the desperately ill and injured was an actual problem in this country once. Poor women in labor, in particular, used to be sent packing. There were stories about people being tossed out of hospitals with knives still in their backs. There were stories of patients dying in ambulances as they were transferred from the for-profit hospital to the county facility.

That’s not the case anymore. Even though it often feels like we’re still arguing over whether everyone should be provided medical treatment, we aren’t. We settled that argument three decades ago with a law to protect the hurting and needy that no one is seriously suggesting we repeal.

In a nation where we’ve decided it’s reasonable to pass laws saying no hospital can deny treatment to people who need it, it’s reasonable to pass laws saying no one can avoid buying insurance coverage to pay for that treatment if they can afford it, and buying it with assistance to pay for coverage if they can’t.

Or, alternately, it’s reasonable to cover the cost of care for everyone by levying taxes. We could then drop the idea of “health insurance,” which is just a piece of paper or a plastic card, and focus on making sure everyone has the health care that matters: doctors and nurses and ointments and salves and machines that go bing and awesome paper pajamas.

We now have one party, Democrats, that would accept either of those options, though it prefers health care for all via taxes. We have another party, Republicans, that doesn’t like either option, and is running Washington. But if Republicans want to prevent people from getting care they can’t pay for, the GOP really needs to repeal the 1986 law. Keeping decent coverage from people who can’t be denied care just means you’re diverting them from doctors’ offices to emergency rooms and making sure their care is as expensive, untimely and ineffective as possible.

What’s most frustrating is that there is a conservative argument on health care that has tremendous import: Because patients getting services so often aren’t paying for them, the industry is immune to the market forces that could drive down costs and foster both innovation and sane consumer behavior.

In efficient markets, providers compete on price and amenities and quality and convenience, consumers know what they’re getting and how much it costs, and those consumers feel the benefit in their wallets when they opt for frugality rather than luxury, or inconvenience rather than frills.

The debate isn’t over whether everyone gets care, and it shouldn’t be over whether everybody gets coverage. The question is how to reward consumers, even if their care is paid for by others, for responsible decisions, and how to reward providers for quality and efficiency. That can be done, but the first step is diverting all the energy we’re devoting to the politics of class warfare toward the problems that really matter.

Lane Filler is a member of Newsday’s editorial board.